ROLE OF CRP AND ERYTHROCYTE SEDIMENTATION RATE IN PREDICTING COMPLICATIONS OF PEPTIC ULCER DISEASE

Abstract

Peptic ulcer disease continues to pose a significant clinical burden worldwide due to its potential for serious complications such as bleeding, perforation, and gastric outlet obstruction, despite advances in medical therapy. Early identification of patients at risk for these complications remains a challenge in routine clinical practice. Systemic inflammatory markers, particularly C-reactive protein and erythrocyte sedimentation rate, are inexpensive and widely available investigations that may offer prognostic value in stratifying disease severity. This study aimed to evaluate the role of CRP and ESR in predicting complications of peptic ulcer disease in a tertiary care hospital setting. A prospective observational analytical study was conducted over a 12-month period at Tertiary Care Hospital, Karachi. A total of 150 adult patients with endoscopically confirmed peptic ulcer disease were consecutively enrolled. Patients with malignancy, chronic inflammatory disorders, systemic infections, or conditions affecting inflammatory markers were excluded. Baseline demographic, clinical, and laboratory data were collected at presentation. Serum CRP levels were measured using an immunoturbidimetric assay, while ESR was determined using the Westergren method. Patients were categorized into uncomplicated and complicated peptic ulcer disease groups based on clinical and endoscopic findings. Data were analyzed using SPSS version 26, with statistical significance set at p < 0.05. Of the 150 patients, 41 (27.3%) had complicated peptic ulcer disease, with upper gastrointestinal bleeding being the most common complication (17.3%), followed by perforation (6.0%) and gastric outlet obstruction (4.0%). Mean CRP levels were significantly higher in complicated cases compared to uncomplicated cases (24.3 ± 9.7 mg/L vs. 8.6 ± 4.1 mg/L, p < 0.001). Similarly, mean ESR values were markedly elevated in complicated disease (38.7 ± 12.4 mm/hr vs. 18.9 ± 7.3 mm/hr, p < 0.001). A CRP threshold greater than 20 mg/L demonstrated a sensitivity of 75.6% and specificity of 87.2% for predicting complications, while an ESR threshold greater than 30 mm/hr showed a sensitivity of 68.3% and specificity of 82.6%. Combined elevation of both markers increased specificity to 92.7%. These findings indicate that CRP, and to a lesser extent ESR, are valuable predictors of peptic ulcer complications and may aid early risk stratification.